1. Field of the Invention
The present invention generally relates to retractors for use in surgery. More particularly, the present invention relates to a moldable retractor particularly adaptable for use in surgery on the extremities, such as the hand.
2. Background of the Invention
In order to perform various surgical procedures it is, of course, necessary to immobilize the area on which the surgery is being performed. In addition, it is necessary and desirable to hold certain tissues out of the vicinity in which the surgeon is working and away from the actual surgical site or to hold sutures or other delicate tissues in certain locations in space. These two interrelated problems of immobilizing certain parts of the body and retracting certain tissues in a particular manner have spawned the development of a variety of devices which are generally referred to as retractors.
In order to perform surgery on a particular part of a patient's body, it is necessary to hold that body part in a stationary position. This allows the surgeon to proceed with the operation in a controlled and efficient manner. The degree of difficulty encountered in immobilizing particular parts of the body may vary widely.
In particular, the problem of immobilizing the subject area is increased when surgery is performed on the extremities such as the arms, legs, hands, feet, and the head and neck which are easily moved by the patient and which may also be moved by relatively small external forces. In addition, because of the relatively small mass of the extremity, as compared to the larger mass of the remainder of the body, the extremities are particularly difficult to immobilize.
An additional problem encountered in performing surgery on the extremities, particularly the hands, feet, head and neck is that delicate and complex surgical procedures are often required as a direct result of the extremely high concentration of bones, nerves, blood vessels, tendons and other similar structures contained within the hands, feet, head and neck. It will be appreciated that the high concentration of structural features encountered in the extremities is a result of the plurality of the complex and delicate movements performed by the hands and feet.
Because of the high concentration of delicate structural features contained within the extremities, it is difficult to perform surgery on the hand or feet. For example, it may be necessary to move nerves and blood vessels out of the surgical area so that tendons or other structures can be repaired. During such a procedure, it is extremely easy to damage the nerves and blood vessels, as well as the tendons. The moving of nerves, blood vessels, and tendons within or away from the surgical area and subsequently holding them in the desired location may be a critical step in the surgical procedure.
It can be seen, therefore, that the dual problems of immobilizing an extremity, and moving delicate structures within or away from the surgical site makes surgery on the extremities tedious and difficult.
In order to aid the surgeon in the performance of this difficult and delicate surgery, various types of "retractors" have been developed. Such retractors are often comprised of a simple annular or circular frame. The frame may be, for example, molded such that it will fit over the particular portion of the body which is the subject of the surgical procedure.
The annular or circular frame conventionally includes means for attaching various "stays" or other types of members to the frame. These stays may, in turn, be used for the purpose of holding various organs or tissue structures away from the surgical area, holding such tissues at desired locations within the surgical area, or they may be used in order to hold the incision open so that the surgeon may perform the surgical procedure without being hindered by closure of the incision.
There are several variations of the type of retractor described above. In one embodiment of such a retractor, it is possible to interchange certain parts of the circumference of the retractor with a section of retractor having a particular specialized shape. This allows the surgeon to modify, somewhat, the exact shape of the circumference of the retractor and provides for use of the retractor in a wider variety of surgical procedures.
As mentioned above, the demands of extremity surgery are unique because of the difficulty in immobilizing the extremity and also the difficulty which is encountered in performing surgical procedures in and around the high concentration of nerves, tendons, blood vessels, bones, and other such structures which are contained within the hand. The retractors described above, which consist simply of an annular or circular frame, have been found to be inadequate for use in hand surgery and other similar procedures because of their lack of flexibility and adjustability in three dimensions in space.
As a result, several attempts have been made to develop retractors which are particularly adaptable for use in extremity surgery. One such retractor comprises a flat sheet of material which is cut into the general outline of a hand. Using this device, the fingers may be strapped to the finger-shaped extensions of the retractor board. This type of retractor has been found to be somewhat useful in helping to solve the problems of immobilizing the hand; however, it is not particularly adaptable for aiding in the actual surgical procedure. That is, it is not adaptable for keeping an incision open or in holding nerves, blood vessels, tendons, and the like in a desired location in three-dimensional space.
Another retractor which is commonly used in hand surgery comprises a paddle-shaped pallet. The paddle-shaped pallet is sufficiently large that a hand may be laid on the pallet without having the fingers extend over the edge of the pallet. The pallet includes a series of notches around its periphery. This allows metal "ball and link" chains to be hooked within the various notches in the desired position. The ball and link chains are then used to hold the surgical incision open or to hold blood vessels, bones, tendons, and the like in a desired position. Furthermore, the pallet may be provided with slots in which straps may be inserted to hold the fingers and wrist in place. This type of hand retractor has seen fairly wide acceptance in the surgical market.
The paddle-shaped pallet hand retractor, however, has several serious limitations. One limitation is that the retractor is not sufficiently weighted to fully immobilize the hand. As a result, relatively small external forces, such as bumping into the hand, will cause the surgical site to move out of place. In addition, it is not possible to move the fingers or the various tissues encountered in the surgical procedure in a three-dimensional manner. That is, it is only possible to hold the hand in place in the horizontal plane of the retractor itself. There is no capability to exert forces in the various other planes such as those substantially perpendicular to the retractor.
Other types of retractors which have been particularly adapted for use in hand surgery include a specially designed surgical table. The surgical table, like the pallet-shaped retractor described above, may include notches in its face so that fingers and the wrist can be strapped to the table. At the same time, the table will include a series of notches along its periphery so that ball and link chains can be hooked into the periphery of the retractor and then used to hold the incision, or other tissues, in the desired position.
Again, this type of surgical table does not allow the surgeon to have three-dimensional flexibility. It is only possible to exert force in the general plane of the surgical table. In addition, this type of surgical table is not sufficiently weighted in order to maintain the hand in the desired position when outside forces of even a moderate magnitude are exerted on the hand or arm.
It can be seen by the discussion of various devices which now exist in the art, that all of the retractors currently in use for extremity surgery and the like have several severe limitations. One of the limitations of all of these retractors is that they are not sufficiently weighted to immobilize the hand and arm as the surgical procedure takes place. Thus, a small amount of accidental force exerted on the hand may move it from the desired position and may cause additional damage to the hand.
An additional limitation in the existing art is the inability to move tissues or hold tissues in a three-dimensional manner and to do so with adjustable directional forces. That is, existing retractors only allow the surgeon to exert forces in the general plane of the retractor (i.e., the "horizontal" plane). If it is desirable to hold tissue up away from the plane of the retractor, this must be done by a surgical assistant or by the surgeon himself. As a result, conventional hand surgery of any complexity requires a wide range of equipment and staff such as is generally only available in the operating room or multiple hands of assistants are required which often block the surgical view or get in the way of the surgical procedure.
An additional limitation on the existing art is that it is not possible to change the plane in which force is exerted on the surgical site. That is, forces which are exerted on the surgical site. That is, forces which are exerted on a surgical area exist only in the plane of the retractor and cannot be changed during the surgical procedure as the needs of the surgical procedure demand. Currently, if it is necessary to provide lifting forces, such as to lift a nerve in a particular manner, the surgeon or an assistant must provide this force and hold the nerve at the desired location for as long as is necessary.
As a result, it is necessary to provide a human aide in order to exert forces on the hand or parts of the hand in directions other than the plane of the retractor. In addition, it will likely be necessary to have an aide immobilize the arm and/or hand of the patient while the surgery is performed. This, however, inherently results in movements of the hand and surgical site as the aide moves. It will be appreciated that even a small movement substantially increases the risk that damage may result to the delicate nerves, blood vessels, and tendons within the surgical area. Such movement can easily cause permanent damage to the patient, especially when microsurgery is required.
As a result, what is needed in the art is a retractor and methods for its use which overcome the limitations which now exist in the art and which are discussed above. It would be an advancement in the art to provide a retractor which was flexible in its use. It would be a related advancement in the art to provide a retractor which allowed the surgeon to exert forces on the hand and the surgical area in a three-dimensional manner.
It would also be an advancement in the art to provide such a retractor which was sufficiently weighted to be able to immobilize the hand during surgery. It would also be an advancement in the art to provide such a surgical retractor and methods for its use which could provide extremely delicate forces for holding blood vessels, nerves, and related structures in a desired position in three-dimensional space. Such a surgical retractor and methods for its use are disclosed and claimed herein.